Patients Leaving English High Security Hospitals: Do Discharge Cohorts and Their Progress Change Over Time?

Long-term outcome studies may be confounded by change in baseline characteristics over time. Our aims were to compare (1) patients' admission characteristics in six high security hospital discharge cohorts (1984, 1996; 1997–2000) and (2) 5-year outcomes for the first two. The special hospitals' case register was used to identify all discharge and individual admission data. Follow-up data were from multiple records sources. The 1984 and 1996 discharge cohorts were similar in size and admission characteristics, except 1996 had fewer people under the legal category ‘psychopathic disorder’ and more prison transfers, similar to later cohorts. Length of high security hospital stay was similar on discharge in 1984 and 1996, but fewer in 1996 went directly to the community and more to other secure settings. Death rates, and high security returns, were similar. Against prediction, the proportion of people re-convicted was not lower in 1996, despite longer overall in specialist security. Relative over-representatio...